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Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < rn <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m o <br /> OrdinanceL Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 p- <br /> r <br /> .v <br /> D e r r Lt7 S-( C► o <br /> R..o... .... .......... ...... .... .... ...... . ..... .... ............. ................................. . . ..... ..... ..... . .... .... ....... ..... . .. <br /> OWNER (please on t) ( CONTRACTOR or SURVEYOR or AGENT o, i0 <br /> h/ /l t S <br /> AD ESS ADDRESS I �U( <br /> o �C nth.�z..: s. .Y.3..... .............. etc. :oma <br /> ADDRESS ... ........... . . ................ .. ADDRESS <br /> a- 9... <br /> .... ........ ...!l..$.y................... ......................................................... .. . . i 1 VI i7 <br /> PHONE e PHONE r <br /> . . .�.. .......... .. ........................................................... ............................................................................................ <br /> V U <br /> PLUMBER WELL DRILLER �� \ <br /> . .............................................................................. A . ................................................. ;w <br /> ADDRESS DDRESS o G <br /> O <br /> ........................................................................................... . ......... ...................................... ....................................... ri <br /> PHONE PHONE.. Z H r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o <br /> 1. Work: 2. New Building Details """%j" <br /> No. Bathrooms o : <br /> �/• <br /> New Building .... Type of nstructio� o No. Bedrooms ..... <br /> Addition .......... ,,,,,,,,,,,,^,,,�rt4 "". Septic Tank Size Gals. ..........0 <br /> Sanitary ... (... Size ...d.7.... ft. x .....J..�.... ft. <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .......................................... Soil Type .................... <br /> Mobile Home Slope ............................. <br /> .......... ............................. `,• ?``J ro <br /> i <br /> Privy .......... 3. Use (describe exact) , 1 family Pere. Rate ................................... <br /> Well .x,,, home,garage, motel Dry Well .......... �, <br /> Seepage Trench .......... <br /> --Subdivision .......... .................................................... <br /> Camping Unit Privy .. : <br /> Seepage Bed K <br /> 01 <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. It property is located at a highway inter- 4' a <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> ---------- ----------------------- __—_-- —_— ? i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — s9. ft. : � ' per. G— <br /> ............................... ............................................................................... <br /> 0 <br /> I <br /> _ <br /> 7 <br /> C Z o <br /> �1 z t <br /> tia <br /> _ <br /> nn � rnrv � � <br /> 9 VIN <br /> m . <br /> Z 0 a a n 71 <br /> o = a $ 3 <br /> EA _ <br /> .......... ... ..... ....... ...... . .. .. . ................. <br /> 0 <br /> �14 /l <br /> Cm <br /> Signa re o n� � Date <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> ......................................................................................................... ........./............9/.........................�................. p . . . . . . <br /> Inspection Date . Q'y'tfo1-:.... !`... m <br /> ....................................... .. ..... .... . o <br /> Zonin Adm nistrator ' 8 8 8 8 8 8 H <br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures involving sanitary facilitins <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be Issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> Ing until a permit has been Issued. A permit may be revoked if misrepresentation of any of the Information conveyed here <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />